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Esophageal Diseases

Overview​

Definition​

  • Definition: A muscular tubular organ located between the pharynx and stomach, slightly flattened front and back.
  • Segments: Upper, middle, and lower.

Development, Structure, and Function​

  • Adult Length: 25 cm.
  • Narrowest Part of the Digestive Tract.
  • Development: Differentiation of a portion of the primitive digestive tract from the caudal end of the primitive pharynx -> Increases in length along with the development of the neck and chest -> Initially lined with a single layer of epithelium -> Overgrowth and even closure -> By 8 weeks, apoptosis and regression of the overgrown epithelium, esophageal epithelium becomes stratified -> Surrounding mesenchyme differentiates into the connective tissue and muscular layers of the esophageal wall.
  • Upper End: At the level of C6, connecting with the lower part of the pharynx -> Descends between the vertebral bodies and trachea -> Passes through the esophageal hiatus of the diaphragm at T10 -> Lower end at T11, connecting with the gastric cardia.
  • Segments:
    • Cervical Segment: From the beginning of the esophagus to the plane of the sternal notch.
    • Thoracic Segment: From the plane of the sternal notch to the esophageal hiatus of the diaphragm: Longest segment.
    • Abdominal Segment: From the esophageal hiatus of the diaphragm to the gastric cardia: Shortest segment.

    Clinically, the segments are also classified using the lower margin of the azygos vein arch and the lower margin of the pulmonary artery as landmarks.

  • Three Narrow Points:
    • At the Beginning of the Esophagus: 15 cm from the central incisor.
    • Where the Esophagus Crosses the Left Main Bronchus: 25 cm from the central incisor.
    • Where the Esophagus Passes Through the Esophageal Hiatus of the Diaphragm: 40 cm from the central incisor.
  • Histology: Typically four layers: (outer) mucosa, submucosa, muscularis, and adventitia (inner).

Gastroesophageal Reflux Disease (GERD)​

Overview​

  • Definition: Reflux of stomach and duodenal contents into the esophagus causing adverse symptoms or complications. Abbreviated as GERD.

Classification​

  • Based on Endoscopic Findings:
    • RE (Reflux Esophagitis): Presence of erosions or ulcers.
    • NERD (Non-Erosive Reflux Disease): No erosions visible under endoscopy.

Etiology​

  • Weakened Esophageal Anti-Reflux Defense:
    • Weakened esophageal clearance capacity.
    • Reduced barrier function of the esophageal mucosa.
  • Attack of Reflux Material on the Esophageal Mucosa.

Anti-Reflux Barrier Components: Lower esophageal sphincter (LES), diaphragmatic legs, esophagogastric ligament, sharp angle between the esophagus and the fundus of the stomach (Angle of His).

Cause of GERD: Primarily dysfunction of the lower esophageal sphincter (LES), a disorder of esophageal motility.

Pathology​

  • RE (Reflux Esophagitis): See endoscopic findings below.
  • NERD: Basal cell hyperplasia, elongation of lamina propria papillae, vascular proliferation, inflammatory cell infiltration, widening of squamous cell spaces. "Inflammation + Hyperplasia + Widened Squamous Cell Spaces".